THE INDUCTION 
OF 
PREMATURE LABOR 
BY AN 
INTERRUPTED-CURRENT DOUCHE OF HOT WATER. 
BY y/ 
S. A. RABORG, M. D. 
HOUSE-SURGEON CENTRAL DISPENSARY ; FELLOW NEW TORK ACADEMY OF MEDICINE ; MEMBER 
NEW YORK COUNTY MEDICAL SOCIETY, ETC., ETC. 
LREPR1N1ED FROM TIIE FEW YORK MEDICAL JOURNAL, NOV., 1876.] 
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D. APPLETON & CO., Publishers, 549 6’ 551 Broadway, N. Y. THE INDUCTION 
OF 
PREMATURE LABOR 
BY AN 
INTERRUPTED-CURRENT DOUCHE OF HOT WATER. 
BY 
S. A. RABORG, M. D. 
tREPRINTED FROM THE NEW YORK MEDICAL JOURNAL, NO V, 1876.] 
NEW YORK: 
D. APPLETON & COMPANY, 
5 4 9 & 551 BROADWAY. 
1876. THE INDUCTION OF PREMATURE LABOR 
BY AN INTERRUPTED-CURRENT DOUCHE 
OF HOT WATER.1 
The important and very thorough papers read before the 
obstetrical section of the New York Academy of Medicine 
last year, by Prof. Isaac E. Taylor, on “ What is the Best 
Treatment in Contracted Pelves?” are still fresh in the minds 
of the profession. As these referred entirely to the character 
of procedure in operating when the physician finds himself 
with a case of contracted pelvis at full term, I desire to place 
before you some views and experience in cases where the 
deformity is known to the practitioner in the early stages 
of pregnancy. The best writers, both in the Old and New 
World, now assert that, under such circumstances, the duty 
of the medical attendant is to produce premature labor at 
such period as will conduce with greatest certainty to the 
safety of both mother and child. This being decided, it 
becomes a matter of serious consideration to appoint a time 
beyond which the mother cannot with safety to either pass 
through labor. 
1 Read before the County Medical Society, September 25, 1876. 4 
It is easily seen that this must differ in almost every case, 
as the size, shape, and deformity of pelvis, as well as the 
apparent size, weight, sex, and condition of child, must be care- 
full v studied to arriye at a proper conclusion. An important 
element of success, also, in performing any operative proced- 
ure affecting childbirth, where haste is not a necessity, is to 
do so gradually and with as little instrumental interference as 
possible ; in other words, to make the labor simulate, as near 
as is in our power, a natural effort at term. 
Cases requiring the induction of premature labor should 
be divided into two classes: 
1. Those where the life of the mother or child, or both, 
is in immediate and pressing danger. 
2. Those where the mother cannot, with safety to herself 
or the child, go to the full term of natural pregnancy. 
The first class includes puerperal convulsions, haemor- 
rhages from placenta prcevise, or other causes; threatened 
death of mother from heart-disease, phthisis, or other trouble, 
where the foetus still shows vitality, etc. 
In the second class are: 
1. Malformation of the pelvis where the antero-posterior 
diameter is as much as two and three-quarters inches. 
2. In cases of women who, from some disease in placenta 
or other cause, are in the habit of having dead children if 
allowed to go to full term. 
3. Where the pelvic diameters are decreased by abnormal 
growths. 
4. Excessive and exhausting vomiting. 
5. Heart-disease of the mother, where the serous infiltra- 
tion of the tissues is so great as to threaten the lives of both. 
6. Renal disease, threatening puerperal convulsions, or 
renal derangement of so marked a character as to load the 
urine with albumen. 
7. Excessive amniotic dropsy. 
Regarding the first class, undoubtedly the duty of the 
practitioner is to use whatever means of delivery promises to 
be most rapid, and at the same time offers the greatest chance 
of safety to both. 
When, however, we approach the consideration of treat- 5 
ment, or surgical intervention in the second class, the case is 
materially altered. 
Here there is no immediate danger, no excuse for rashness 
or haste. Cazeaux, in speaking of this subject, says : “ The 
best operation is that which is the most uniformly and rapidly 
successful, at the same time that it affords the greatest secu- 
rity to both mother and child.” This aptly applies to the first 
class, but not to the second. Nature does not perform this 
w’ork in a short time. We know that at term there is always 
a preparatory stage of a week or more : then why not try to 
reach an operative procedure which will, as near as possible, 
imitate natural labor? Many measures have been proposed 
for this purpose, having in view' the fact that less risk would 
attend premature delivery if it could be induced without 
absolutely passing into the confines of the uterus with surgi- 
cal or other means. In the earlier times bleeding w7as 
advised ; afterward stimulating the womb by reflex action 
—by mustard-plasters and blisters over breasts. Scanzoni 
recommended the application of gum-elastic cups over the 
breasts. Then came external manipulation over the abdo- 
men to excite uterine contraction ; and, again, ergot had its 
day. But probably the person who more thoroughly ap- 
preciated the position than any other was Prof. Kiwisch, of 
Wurtzburg, who, in 1846, introduced the use of the vaginal 
douche by an injection-pipe, closely resembling the one now 
sold in the stores called the fountain-syringe. Ilis plan is 
known to you all. He entered the nozzle of the syringe high 
up in the vagina, and directed a steady current of hot water 
against the os for some minutes. This wras repeated at inter- 
vals, until the muscular coat of the uterus was excted to 
contraction. Many modifications of this operation have been 
attempted.1 “ M. Blot on several occasions even inserted the 
canula into the neck, so that the jet reached and detached 
the membranes. This is well calculated to bring on labor 
within a very short time.” The practice of Tyler Smith in 
using alternately the cold and hot currents of water has never 
been received favorably in this country ; it certainly would 
suggest danger by shock to the nervous system, and to a deli- 
Cazeaux, ]>p. 1011. 6 
cate constitution the rapid change from one extreme of tem- 
perature to tlie other might be productive of the worst conse- 
quences. 
“ Dr. Cohen, Dr. Leopold Harting, and Dr. Stultz, intro- 
duced a small tube through the os uteri, and directed the 
stream of water between the walls of the uterus and the 
membranes. Twenty-three cases have been recorded by 
them.” 1 
During the last six years I have performed on the same 
patient the operation of Kiwisch once, and twice a modifica- 
tion of his method by substituting an interrupted current, as 
is caused by the Davidson syringe. 
My purpose to-night is to mention as briefly as possible 
the notes of two of these cases, and then demonstrate as fully 
as I can the advantages of the interrupted current in pro- 
ducing a character of labor which simulates very much the 
natural effort at term. I will first give a synopsis of the ac- 
couchements of the mother of the lady above referred to: 
Mrs. II., the mother, from her husband’s account, was a 
brunette of medium size, in good health when he married 
her, and gave birth to her first child when she was twenty- 
five years old. The history of the labors of this lady is 
very vague, but I will recite it as it was given to me. The 
first child was a boy, and, in order to deliver him, her physi- 
cian was obliged to perform craniotomy first, and then ver- 
sion. One year later a second child \vas brought into the 
world in the same way. Thirteen months from this period 
she had a miscarriage of some four months. Sixteen months 
after this, a small girl child, born with instruments and sup- 
posed to have been dead in utero a month before delivery. A 
year and a half later, another male child was destroyed and 
then delivered. The sixth child, a girl, and my present pa- 
tient, was born prematurely and safely at seven months. 
The birth was not hastened by any interference of her 
medical attendant, and the mother was not aware of any rea- 
son for the early delivery of the child. The babe weighed, 
after it had been wrapped up in flannel, only two and a half 
pounds, according to the statement of the father, but I pre- 
1 Churchill, “ System of Midwifery,” pp. 308. 7 
sume this must be an exaggeration. About twenty months 
after the birth of this little girl, Mrs. H. had a seventh child, 
a boy, which was destroyed and taken from her. An hour 
after the operation, the unfortunate lady died of haemorrhage 
and exhaustion. The only child she left, the little girl above 
referred to, grew up to womanhood, and at the age of eigh- 
teen and a half years married a Mr. L. Ten months after 
her wedded life began, a distinguished German physician was 
called to attend her in labor. He found a contracted pelvis, 
and, seeing that a natural delivery was impossible, he per- 
formed craniotomy and afterward version. 
In the latter operation he fractured one leg and one arm 
of the infant, and finally succeeded in delivering it, but at 
the same time rupturing the entire perinaeutn into the rectum 
of Mrs. L. Before the child was delivered the lady had sev- 
eral puerperal convulsions. She was confined to her bed for 
three months after this delivery; her urine was drawn from 
her with a catheter for over two weeks, and for a long time, 
until the formation of eicatricial tissue, she had no power over 
the sphincter ani. Ten months later she had a miscarriage 
of eleven weeks. The third pregnancy culminated thirteen 
months after this miscarriage, when a daughter, still alive, 
was born with forceps. This child was very small, weighing 
about five pounds. Twenty-one months later she successfully 
delivered, without surgical intervention, a very small boy, 
weighing a little over four pounds. This child also lived. 
Two years and one month later her fifth child, a boy, was 
destroyed and delivered. 
About fifteen months after the last birth I have recorded, 
Mrs. L. called on me and stated that her physician, who had 
taken charge of her through her five previous pregnancies, 
had gone abroad, and she desired to place herself under my 
care, and gave the above history. Upon examination I found 
her to have the following proportions: height in stocking-feet, 
fifty-nine and a half inches, or half an inch less than five feet. 
Assisted by Prof. F. U. Otis I made a careful examination of 
the diameters of the pelvis, and found the antero-posterior or 
sacro-pubic diameter, by the fingers, measured only two and a 
half inches; but, using King’s pelvimeter, this could be made 8 
to register two and three-quarters inches, but by so doing 
the patient seemed to suffer much pain. The transverse 
diameter measured just about the same (namely two and 
three-quarters inches witli pressure of pelvimeter); the ob- 
lique diameter measured also about two and three-quarters 
inches. She had consequently a uniformly-contracted pelvis. 
The difficulty was evidently in this case confined to the 
superior strait. The pubic bones were firmly knit to- 
gether, and the rim, or top, of the pelvic basin seemed to go 
from this union in quite an acute angle. The external meas- 
urement between the tuber ischia was four inches. After 
confinement I found that Mrs. L. had a measurement around 
the hips, bringing the tape-line from behind to the front and 
just below the crest of the ilium, of thirty-two and a half 
inches ; and below, around from behind by tuber ischia to 
pubis in front, of thirty-four inches. Iler physical condition 
was any thing but promising. She was anaemic, with haggard 
aspect, her pulse weak; a decided amount of albumen was 
found in her urine when examined by heat and with nitric 
acid; and the most remarkable of her symptoms was a con- 
stant disposition to syncope; in fact so great was this that she 
would faint away eight to ten times during twenty-four hours, 
and remain insensible from five to twenty minutes during 
each attack. She told me she surely would die with the birth 
of this child, and her fear and anxiety were pitiable to wit- 
ness. I felt at once the responsibility of such a case, and the 
discretion and judgment necessary to extricate the lady from 
her perilous condition. I, however, encouraged her as well 
as I could, and gave her a tonic of mur. tinct. iron, gtts. x, and 
quinine sulph., gr. ij, every three hours in simple sirup. This- 
was about the end of December, 1870. By calculation from 
the date of the commencement of her last menstruation, her 
eighth month would terminate the 4th of the next month 
(January, 1871). Prof. F. N. Otis saw her with me the next 
day, and we determined upon the induction of premature 
labor, commencing on the latter date. Feeling the necessity 
here of being very cautious to avoid nervous shock, we de- 
termined to use a simple douche three times a day, and, think- 
ing that probably an interrupted current, which could be pro- 9 
duced with a Davidson syringe, would be more apt to bring 
on gentle uterine contractions than the continuous current of 
Prof. Kiwisch, this course of action was determined on. At 
eleven o’clock in the morning of January 3, 1871, Dr. Otis 
met me at the house of patient. We allayed her fears by 
showing her the Davidson syringe and explaining the douche 
to her, and assuring her we did not intend to use any other 
instrumental means to effect her delivery; that the labor 
would be brought on so gently, it would seem as if it was the 
work of Nature, but that she must not expect the advent of 
her babe under a week. 
A preliminary examination showed the os high up and 
rigid ; the point of the index-tinger could, however, readily pass 
through it, and a vertex presentation was determined. The 
vagina was quite dry. She was then placed by her nurse in 
position, in bed, on a rubber cloth, the ends of which were 
brought down into a large tub; her hips rested on the ex- 
treme edge of the bed, and her feet on the sides of the tub. 
Iler head was kept moderately high by three pillows tucked 
under the rubber at her back. A bucket containing two gal- 
lons of water, of temperature 100° Falir., was then placed in 
the tub, and after oiling the long tube I inserted it and gave 
her the douche of this quantity against the posterior lip of os. 
After this about an ounce of olive-oil was thrown high up in 
vagina, to counteract the extreme dryness apt to result from 
so hot a douche. She bore the operation remarkably well. 
She was then advised to get up and walk about, and, if she 
felt well later in the day, to take a short ride. Her diet was 
made generous, but of easily-digested material. At 9 p. m. 
I saw her again, and found her very comfortable. She com- 
plained that during the afternoon she had had constant 
bearing down, as if she wanted to go to stool.” The douche 
was repeated in the same manner, and the patient allowed to 
retire for the night, 10 
Thursday, January 4th, 1 p. m.—Was detained from Mrs. 
L. until this hour by case of labor. Found her comfortable ; 
she had occasional pain low down in back. Os less rigid, di- 
lated to size of silver quarter. Gave douche of two gallons, 
and advised her to move about freely. 5 p. m.—Mrs. L. seemed 
somewhat exhausted, ordered milk-punch; condition other- 
wise the same. Repeated douche. 10 p. m.—Os more dilat- 
able, but hardly any pain ; again gave douche. 
Friday, January 5th.—At 11 a. m. found Mrs. L. some- 
what irritable about pains she frequently had in back, “little 
trifling things,” as she expressed it, “ such as she always had 
for two or three days before labor.” Gave douche, but in- 
creased temperature to 110° Falir., and all subsequent ones 
were of this temperature. She at first complained of the ex- 
cessive heat, but only for a minute or two. During this 
douche she had two quite severe pains. I should have stated 
that on all these days she continued to have her fainting-at- 
tacks, but not more than five or six in twenty-four hours since 
she had been taking her tonic. She never had one while she 
was receiving the douche. 5 p. m.—Same condition ; gave 
douche. 10 p. m.—Found Mrs. L. restless and nervous; had 
fainted twice since my last visit; constant pains in small of 
back, and frequent desire to micturate. During the afternoon 
it had grown intensely cold, and she seemed to feel it. The 
os more dilatable, and bag of waters pressing down to some 
extent. I introduced my finger and swept it around the 
lower segment of uterus, separating to some extent the mem- 
branes. This was the only mechanical interference on my 
part in this case. Gave douche. p. m.—Called suddenly 
to my patient; found she had had a nervous rigor. I ques- 
tioned her closely; she had no disagreeable head-symptoms, 
no puffiness of the face, no derangement of vision, but there 
was considerable oedema of lower limbs. Prof. A. Flint, Jr., 
had examined her urine, and found a good deal of albumen, 
but no indication of positive renal trouble. Gave her a warm 
brandy-punch, and she soon went to sleep. 
Saturday, bth, 11 a. m.—Mrs. L. dressed and walking 
about room; feeling in better spirits and looking bright 
and cheerful. Os dilated to size of half-dollar, but with a 11 
rigid u whip-cord ’’-like edge, otherwise condition the same; 
pains constant, hut not of a character to effect much benefit. 
Douche. 4 p. m.—Again douche. 10 p. m.—Bag of waters 
pressed lower down, but os still rigid. Douche. 
tSunday, 10 a. m.—Pains more frequent, but still not posi- 
tive in character ; Mrs. L., however, feeling well; at each visit 
she says she “ is counting the hours to terminate her week.” 
Os not quite so rigid. Gave douche. 4 p. m.—Douche. 10 
p. m.—Pains more positive in character; waters pressing down ; 
vagina full of secretion ; os giving way, and every indica- 
tion of labor. Repeated douche for the last time and ordered 
patient to retire and try to obtain some sleep. 
Monday, 1 \th, 11 a. m.—Pains severe; membranes rup- 
tured during one of these, and the fluid escaping in large 
quantities; the os dilated to size of silver dollar, but thick, 
hard, and unyielding; ordered patient to bed, and had her 
nourished on wine, beef-tea, and milk. Having determined 
from the first not to interfere unless there was some pressing 
danger, and as she had steadily improved in general health 
from the time she commenced to take the tonic, Nature was 
left to do her own work. 6 p. m.—Hard labor commenced, but 
it was well borne. The head remained fixed in the bony 
strait of the pelvis for two hours, and I greatly feared I would 
be obliged to apply forceps, but finally, about 11£ p. m., I suc- 
ceeded, by pressure above the pubes of the mother, in assisting 
her during one of her severe pains, and had the pleasure of 
seeing her give birth to a plump boy weighing five and a half 
pounds. The placenta came away without unusual trouble, 
and the patient was left comfortable and happy an hour after 
the birth of the child. 
Tuesday, 12 m.—Mrs. L. in excellent condition; says “she 
never has felt so well after any of her previous confinements.” 
She has passed her urine twice; pulse 80 ; haemorrhage about 
natural. Condition of child good; has passed both urine and 
faeces twice. It is useless to pursue the subject further. Mrs. 
L. made a happy recovery, without a trouble of any character 
to mar it. Her milk appeared on the third day, and she 
nursed her boy, who grew finely, and is well and strong to-day. 
It will thus be seen that in five days and twelve hours this 12 
delivery was effected with hardly any inconvenience to the 
mother, and perfect safety to the child, by the simple David- 
son syringe throwing an interrupted current of hot water. 
Mrs. L. continued my patient, and again became pregnant 
about the 18th of October, 1873. This would make her mean 
time for delivery about the 20th of July, 1874. Her physical 
condition during this pregnancy was much better than the 
last. Digestion good, bowels regular; constant examinations 
of urine showed only a trace of albumen, and she had none 
of the fainting-spells. Her mind also was at ease, as, after her 
last comparatively easy delivery, she felt under my care safe 
for the future. The pregnancy progressed favorably, and 
in consultation with Prof. Otis it was again determined to 
allow her to go to the termination of the eighth month. This 
would be between the 18th and 20th of June. About the 
10th of that month I made a preliminary examination, and 
found a very rigid os, high up, and almost completely closed. 
Gave her a small dose of extract of belladonna three times a 
day. 
Thursday, June, 18, 1874.—Met Dr. Otis, at 1 p. m., and 
we found the belladonna and a laxative she had taken had 
had an excellent effect in relieving the rigidity of the os, 
as it was much softer, and readily admitted the index-finger. 
In approaching this second operation, I had determined to 
use the continuous carrent of hot water from a fountain- 
syringe, as advised by Kiwisch. For this purpose, had con- 
structed a tin can with tight cover, and capacity of over 
two gallons. From the bottom of this was inserted a tin 
tube so arranged that the flow of water could be controlled 
and its force increased or lessened at pleasure. Over this 
tube the long rubber one was attached and then the can lifted 
three feet above the level of the bed by means of a light rope 
and pulley attached to the ceiling. Feeling so much in favor 
of the interrupted current, and for fear I might be prejudiced, 
made up my mind to give the continuous current the same 
opportunity the interrupted had had with last labor. After 
everything was arranged we gave the first douche of two gal- 
lons of water, at 110° Fahr. This was borne well, but, when 
the olive-oil had been injected and the patient allowed to rise, 13 
she was attacked by sudden weakness, and we were obliged 
to give her some stimulant. After this she was sent out in 
the open air. 5 i\ m.—No appreciable change in os ; patient 
comfortable ; gave douche. Up. m.—Os seemed more dilata- 
ble and softer ; gave douche. 
Friday, 10th, 10 a. m.— Mrs. L. doing remarkably well 
as to general health. Os higher up, and if anything more 
firmly contracted, than yesterday morning ; gave douche ; or- 
dered active walking, but not to the point of fatigue. After 
each operation the weakness spoken of occurred, and I was 
obliged to administer brandy-and-water. This weakness was 
never shown after use of interrupted current. 4 p. m.— 
Douche. p. m.—Douche. No positive change in condi- 
tion of patient. 
Saturday, 20th, 11 a. m.—Patient was awakened two 
or three times through the night with pain ot an irritating 
character ; said “she felt as if something within her was bear- 
ing down digital examination revealed no appreciable change, 
except that the os seemed lower in vagina—gave douche. 
Mrs. L. has had a natural evacuation each day from bowels; 
passed urine freely, and this upon examination shows only 
traces of albumen. 4 p. m.—Douche. 9 p. m.—Douche. 
Sunday, 21st, 11 a. m.—On examination, os seemed softer 
and more dilatable; she stated that ‘‘during night and 
morning, at intervals of a halt-hour, slight pains had occurred 
in lower part of abdomen always before her pains commence 
in the back.” Some little nausea. Gave douche. 5 p. m. 
—Condition same; douche. 9| p. m.—Patient complained of 
“ pains lasting longer and being sharper.” Found os lower 
down, but still a hard ring, not larger than silver half-dollar; 
introduced finger to second phalanx, and swept it round, sepa- 
rating the membranes. Gave douche. 
Monday, 22d, 11 a. m.—Patient had suffered with small 
pains since last night. General condition good. Con- 
dition of os not appreciably changed. During douche tw*o 
quite severe pains, caused, no doubt, by my directing current 
directly within the os. 5 p. m.—Douche. 11 p. m.—Pains 
more frequent, about every fifteen minutes. Os seemed 
softer. Douche. 14 
Tuesday, 11 a. m.—The regularity with which pains 
occurred yesterday has all passed away. Only a slight con- 
traction at long intervals, and felt in lower part of abdomen. 
General condition good. Gave douche. 5 p. m.—Douche. 
9-| p. m.—Condition unchanged. Mrs. L. getting impatient. 
Made some effort at dilatation with fingers, then gave douche. 
Wednesday, 2R/<, 10 a. m.—To my great chagrin and 
disappointment, found condition of patient the same. She 
had some disposition to diarrhoea during the night; seemed 
languid, and said she “ had lost her appetite.” 1 p. m.—Gave 
douche. 5 p. m.—Repeated douche. 
Still no positive sign of labor, and as the time of the opera- 
tion had already exceeded by twenty-four hours the time of 
delivery of the first case with the interrupted current, the 
patient being irritable and weaker, I determined to resort to 
more active means to hasten the delivery. Introduced the 
smallest size Barnes dilator. 9 p. m.—Returned, and found 
dilator in vagina, and introduced second size. Up. m.—Pa- 
tient fretful and weak. Os more dilatable and softer, but no 
sign of positive labor; gave nervous anodyne, and ordered 
patient to retire for the night. 
Thursday, 25th, 10 a. m.—Mrs. L. in better condition, 
but os had again contracted down and presented same con- 
dition as previous morning. Gave douche, and, as Dr. Otis 
had left towm, requested Prof. Erskine Mason to meet me in 
consultation at 2 p. m. At that hour, after careful considera- 
tion, we thought, with the rigidity of os and the good condi- 
tion of the patient, that it was better not to rupture mem- 
branes. The douche was given, and again at 10 p. m. 
Friday, 2§th.—Some greater dilatation of os. Bag of 
waters pressing lower down in vagina. Sent patient out 
for a walk after giving douche. At 6 p. m. found patient in 
same condition, and with consent of Dr. Mason ruptured the 
membranes during next pain. She at once lost a large quan- 
tity of amniotic fluid, so it was considered safer to keep her 
in bed; the presentation we both distinctly felt to be vertex. 
Saturday, 212 m.—Dr. Mason met me at this hour 
by appointment. I was to have been sent for if her pains 
were more severe before that time. She informed us that 15 
she had passed a comfortable night, had been disturbed 
occasionally with small pains, but that toward morning the 
active motion of the child had ceased. Upon examination, a 
shoulder was found presenting. The os was softer and dila- 
table. Dr. Mason gave her chloroform, and I quickly per- 
formed version. Having secured one foot and leg, passed my 
hand up to bring down the other, and found the cord between 
the limbs ; slipping this off, with very little difficulty, the body 
was brought down. Had some trouble with the head in the 
superior strait, but after a few moments it was delivered. 
The cord was wound around the neck twice, and, during the 
change of position of the foetus through the night, had in some 
way got between the limbs. The child gasped some two or 
three times, and Dr. Mason, for an hour, tried to resuscitate it, 
but without avail. It weighed nearly six pounds. The pla- 
centa was delivered without trouble, and the uterus contracted 
down well. She had, however, considerable “ after-pains,” 
and we gave her one-fourth of a grain of sulphate morphia at 
once, and ordered her to have one-sixth every three hours if 
required. Next morning her pulse was 120°, skin normal, 
abdomen soft; had urinated twice; tongue moist, soft, and 
clean. 5 p. m.—Found her with great tympanitis—pulse 120. 
Cutting pain in left groin. For several days after this she 
was very ill; but, by use of opiates and other appropriate treat- 
ment, she finally recovered. 
Time from first douche to delivery, nine days. 
I have detailed the circumstances connected with these 
two cases so fully, because it was necessary to demonstrate 
the difference of action between the continuous and inter- 
rupted currents of hot water on the muscular fibres of the 
uterus. With regard to the third case, 1 will speak of it very 
casually, and detain you only a few minutes longer. 
Mrs. L. was not seen for some months, when on Wednes- 
day, April 12, 1876, she came to my office and informed me 
that she had not menstruated since September 24, 1875. 
This would have made her mean time of delivery about June 
25, 1876. She, however, presented the appearance of a 
woman who had reached full term. Upon questioning her, 
she informed me that during the last month her abdomen 16 
had increased rapidly in size. The next day, Thursday, as- 
sisted by Prof. E. Mason, a careful examination was made of 
her condition. AVe decided that she had an amniotic dropsy. 
The foetal pulsation was very feeble, the os high up and rigid. 
The lower limbs of mother much swollen and oedematous, 
and her urine containing a decided amount of albumen. In 
addition to all this her general condition was not so good as 
in the second labor. AFe determined under the circum- 
stances, fearing the life of the child and also danger to the 
mother, to induce labor as soon as she reached the end of the 
seventh month. This brought her to the 24th of April. On 
the evening of that day, Monday, the first douche was 
given with Davidson’s syringe, of two gallons of water, of a 
temperature of 110° Fahr. On Tuesday, 25th, three were 
given. Wednesday, 26th, three were given, and in the even- 
ing of that day she felt decided pains. Thursday, 27th, three 
were given. Friday, 28th, three were given—all borne well; 
patient attending to her household duties and going about as 
usual. Saturday, 3 p. m., last douche given; pains about 
every fifteen minutes; membranes pressed down in vagina; 
os cpiite dilatable. 10 r. m., Saturday, Mrs. L. progressing 
favorably. 5 a. m., Sunday, April 30th, sent for in haste; 
found patient in second stage of labor; membranes had rup- 
tured during the last pain. At 9 a. m. she, without assistance, 
gave birth to a little girl, weighing only three pounds. The 
child was feeble, but did well. Mrs. L. had no trouble what- 
ever, and made an excellent and speedy recovery. 
Time from first douche to delivery, five days, eleven and 
a half hours. 
KECAPITULATION. 
First Child.—First douche, Wednesday, January 3, 1872, 
a. m. Delivered Monday, January 8, p. m. Time of 
labor from first douche with interrupted current by David- 
son’s syringe, five days and twelve hours. 
Second Child.—First douche, Thursday, June 18, 1874, 1 
p. m. Delivered Saturday, June 27, 12 r. m. Time of labor 
from first douche with continuous current of Kiwisch, as- 
sisted by Barnes’s dilators, and final rupture of membrane, 
nine days and twenty-three hours. 17 
Third Child.—First douche, Monday, April 24, 1876, 
p. m. Delivered Sunday, April 30th, 9 a. m. Time of labor 
from first douche with interrupted current as in first case, 
five days, eleven and a half hours. 
It is very evident, from the above, that the continuous cur- 
rent cannot he relied upon as a sole agent to induce prema- 
ture labor. The first shock from this constant stream cer- 
tainly produces an impression, and causes some softening and 
dilatation ; but after this period the effect is to paralyze more 
than excite to action, as is shown in Case II. 
The rationale of the action of the interrupted current is, 
first, a sort of flagellation to the muscular tissue of the uterus. 
The Davidson syringe, with each pressure of the bulb, throws, 
with a force corresponding to the quickness of the compress- 
ing power, about an ounce and a quarter of the fluid against 
the os. Consequently, to discharge in this manner two gal- 
lons, will take about twenty minutes, and require the bulb to 
be emptied in the neighborhood of three hundred and sixty- 
eight times. Repeat this three times a day, and we can 
readily see the disposition to action which such a prolonged 
and constant stimulus must give to so sensitive an organ as 
the uterus. That the effect is stimulating to the entire or- 
ganism is shown in Cases I. and III. Mrs. L. absolutely 
improved in health during both deliveries, never grew faint 
under the operation, and always arose from her couch in good 
spirits and without feeling any inconvenience. 
To the contrary, after the continuous current in the second 
case, she was so faint at the termination of each douche as 
to require assistance and stimulation. It must be remem- 
bered also that the patient was in much better condition of 
health during the second labor than in either of the others. 
For my second line of reasoning I am entirely indebted to 
the articles written on the subject of hot-water injections by 
Dr. Thomas Addis Emmet. As far as I can understand, he 
has taught since 1860 that the secondary effect of hot water 
applied in this way was to cause contraction. In his “ Philos- 
ophy ot Uterine Disease,” page 19, he says : “It is generally 
conceived that the application of heat by this method relaxes 
the vessels and increases the congestion. This it does at first, 18 
but, if prolonged, the capillaries are excited to increased ac 
tion ; as they contract, the tonic stimulus extends to the coats 
of the larger vessels, and their calibre becomes lessened.” 
On this ground I contend that the action of the inter- 
rupted douche of hot water by mechanical and constantly- 
recurring stimulation acts more rapidly than the continuous 
current, and first causes the smaller vessels about the os to 
contract, then the larger ones within the uterus. The result 
of this undoubtedly lessens the size of the womb itself, and, 
after the injection ceases, the returning flow of blood assists 
in exciting the organ to activity. 
It will no doubt be considered by many that, in Case II., I 
should have sooner adopted some operative procedure to ter- 
minate the labor, but it must be remembered that each day I 
hoped to find natural contractions; and, besides, the patient 
was going about attending to her ordinary duties, and in no 
apparent danger. 
In Case I. no account was kept of the foetal pulsations; 
but having read the paper of Dr. F. C. Wilson, of the Louis- 
ville City Hospital, before the commencement of the second 
case, an accurate examination was made for this purpose 
several times in Cases II. and III., with the following result: 
Second Case.—Average number of foetal pulsations, 136. 
The child was a male. 
Third Case.—Average number of foetal pulsations, 160. 
The child was a female. 
Dr. Wilson says: “ From 134 to 138, the sex will be doubt- 
ful, with chances in favor of female. From 143 to 1Y0 the sex 
will be almost certainly female.” It seems to me, however, that 
these rules cannot be laid down with any absolute certainty, as 
so much must depend upon the condition of health of the 
mother, and the action of her circulation. 
A point of interest in this case showing the hereditary 
transmission of a certain part of the organism of one or the 
other parent to the offspring is demonstrated in the fact that, 
some time after the death of the mother of Mrs. L., her father 
married a second time. The first fruit of this wedlock was a 
girl—now a Mrs. G., living in this city. She is four years 
younger than Mrs. L.; it has been my duty to attend her 19 
twice in labor, and she lias a perfectly normal pelvis in shape 
and dimensions. 
What are the advantages of this method compared with 
those now in vogue ? 
From the time of Dr. Macaulay, of England, who about the 
year 1756 or 1757 first induced premature labor, until that of 
Prof. Kiwisch, in 1846, every delivery of this kind was made 
with more or less instrumental interference. The latter un- 
doubtedly appreciated the fact that the effort in this direction 
which most simulated the action of Nature would promise the 
greatest safety to mother and child. Hence his continuous 
current of hot water against the os. 
The objections to perforating the membranes are manifold. 
The liquor amnii may escape so rapidly as to bring the wTalls 
of the uterus in direct contact wdtli the child, thus endanger- 
ing its existence. 
As in Case II. related, the position of the child is liable to 
change. This has been thoroughly demonstrated at the “ Ma- 
ternite in Paris by Dubois.” 
Again, it may make the delivery tedious, by causing what 
is termed dry labor. 
The dilatation of the os uteri by compressed sponge is the 
least objectionable of the forcible means for the induction of 
labor, but it is not always an easy matter to introduce pre- 
pared sponge of this kind without causing a good deal of irri- 
tation about the parts. In addition to this, statistics show 
that it has failed in a large number of cases.1 
Schoeller’s vaginal tampon is, I believe, but little used to- 
day, on account of the great annoyance and suffering it caused 
the patients. 
Barnes’s dilators are invaluable where great haste is re- 
quired, in cases of haemorrhage or puerperal eclampsia. 
The mechanical procedure of Mampe, and others, of intro- 
ducing gum-elastic bougies; Cohen’s uterine injection, and 
forcing other foreign substances, between the walls of the 
uterus and the membranes, to stimulate contractions by sepa- 
rating the latter from the former, must, one would suppose, 
1 Bedford, “ Principles and Practice of Obstetrics,” p. 675. 20 
give way entirely to the operation now performed by Prof. T. 
Gaillard Thomas. In an interview with that gentleman a tew 
days ago, he gave me a minute account of his procedure. He 
introduces the nozzle of a Davidson’s syringe to the os inter- 
num ; this is held stationary by placing a finger on either side of 
the os externum ; by this means, also, the rapid exit from the 
uterus of a portion of the fluid is temporarily prevented. The 
hot water is then gently thrown against the membranes, and 
between them and the body of the womb, thus separating the 
former and bringing on rapid contractions. lie assured me 
that within twenty minutes the os would dilate to the size of 
a silver quarter, and that more than twenty-four hours were 
hardly ever required to complete the delivery, and frequently 
this object was accomplished in a much less time. One case 
where the first injection was given at seven o’clock, r. m., the 
babe was born by midnight. He also informed me that, al- 
though at his advice a number of physicians had tried this 
method, he had as yet to hear of the first unfortunate result. 
It will be noticed that this operation of Prof. Thomas differs 
in two particulars from that of M. Blot, Dr. Harting, and 
others, as mentioned in the early part of this paper, in that he 
uses the interrupted current of Davidson’s syringe, and by 
placing a finger on either side of the os externum the partial 
return of the fluid is prevented. Although the doctor has 
been so successful with these intra-uterine injections, there 
are gentlemen on record who have not been so fortunate in 
injecting the pregnant womb. Cazeaux, in speaking of this 
subject, p. 1011, says : “ I also reported several cases of sudden 
death while the douche was being administered under the 
charge of such men as MM. Depaul, Salmon (of Chartres), 
and Simpson, whose skill is beyond questioning. Prof. De- 
paul, in relating his own case to the Surgical Society, thought 
he could account for the event by the introduction of a few 
bubbles of air into the uterine sinuses, and I think his expla- 
nation a good one, for in every instance the symptoms ob- 
served were those produced by the entrance of air into the 
veins.” Prof. Leischman,1 of Glasgow, says, “ Simple and safe 
1 Leischman’s “ System of Midwifery,” p. 530. 21 
as this method may appear, later experience has shown that 
it is by no means free from risk, and fatal cases have been re- 
ported, in which death had occurred.” 
We all know that, for a week or twTo prior to delivery at 
natural term, the uterus, os, and soft parts, are preparing for 
the advent of the foetus. The organ sinks lower in the cavity, 
the os becomes softer and dilates to some extent, and the soft 
parts secrete an abundance of mucus to lubricate the passage, 
and assist the linal expulsive efforts of the womb. It will be 
remembered that in Cases I. and III. the delivery required 
five days and a half. The latter labor was accomplished in 
one half hour less time than the former. Consequently, from 
the character of the stimulant given to the organ to bring on 
gradual contractions, this preparatory stage, as in normal la- 
bor, was accomplished. This operation- promises undoubted 
safety to both mother and child. There can be no compara- 
tive danger from inflammation of the soft parts, or the organ 
itself, in case the blood or tissues of the mother are deterio- 
rated by any constitutional poison, because they are not in any 
way injured. The operation requires patience on the part of 
the medical attendant; but our profession is noted for possess- 
ing that virtue. And, lastly, the interrupted-current douche 
does not oblige the practitioner to penetrate beyond the exter- 
nal os. If we can succeed without this, we are fortunate, 
for the pregnant womb is a sacred tabernacle, containing life, 
the most precious of all the gifts of God, and, as such, deserves 
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